Emergency Endovascular Treatment of Petrous Carotid Artery False Aneurysm

Introduction: The management of ruptured intracranial false aneurysms (IFA) might betricky as any kind of treatment modality, surgical or endovascular, is burdened with significantchallenges. A case report of the endovascular treatment of IFA in emergency setting is presented toprovide more understanding of its pathophysiology as well as of the best operative work-up forpetrous carotid artery reconstruction. Methods: Technical notes from a left sided skull base abscess,involving and eroding the carotid canal and petrous carotid artery (PCA) resulting in an IFA are shownand analyzed. Results: Balloon-assisted low viscosity Onyx embolization seems an effective method forthe emergency treatment of IFA. Indications, technical nuances, and peri- and post-proceduralcomplications are thoroughly discussed. A flow chart for the management of IFA is also proposed.Conclusions: The combination of parent artery balloon protection and low viscosity Onyx embolizationcan provide an effective occlusion of the IFA while maintaining parent artery patency. Normal distalfilling of the parent artery, and optimal obliteration of the IFA are easily achievable